VA Secretary Robert Wilkie on Tuesday asked a Senate panel for nearly a 10% funding boost for VA medical care, primarily for private treatment and to aid the department's consolidation of all community health choices by June 6.
While the funding would go toward private treatment, Wilkie told the Senate Veterans' Affairs Committee several times that he doesn't support privatizing the agency's healthcare system.
"We don't privatize the VA because we still have the largest healthcare system in the country, with 170 hospitals, and our veterans are voting with their feet," he said. "This is not a libertarian VA. If it were, I would be giving myself a card that says veteran and go out to the public sector and get everything I want. I fall back not on anecdote but on stats, that our veterans are happy."
The White House budget asked for $84.1 billion for the VA, which is $4.6 billion over last year's budget, as the department transitions to the new system mandated by last year's VA Mission Act. The funding is estimated to pay for treatment of 7.1 million veterans in 2020.
Wilkie came under fire from Democrats over the recently proposed access standards, released for public comment in late January. After the hearing, the committee's ranking member, Jon Tester (D-Mont.), told Modern Healthcare his main contention over the access standards is whether the department will use them to measure private hospitals and physicians as well as the VA.
"Are they going to be able to utilize their standards, and be critical of the private sector if they don't meet the VA standards of time, and access, and quality of care?" Tester said.
He included the caveat that he thinks the budget should put the VA "in good shape" as long as it's well-administered and noted that he doesn't personally believe Wilkie is an advocate for privatization.
While the VA access standards have yet to be finalized, the department is working on other aspects of implementation, including the contract awards for insurers who will pay private hospitals and physicians. The stakes are high for the private medical sector, that under VA Choice complained of late and underpayments.
Under the VA Mission Act, the U.S. has been split into six regions, each of which will be administered separately by various insurers.
So far, the department has awarded three of the six awards to UnitedHealth Group's Optum Public Sector Solutions.
Two companies have lodged protests against the contracts for regions 2 and 3 with the Government Acccountability Office: TriWest HealthCare Alliance Corp., which administers a swath of the current VA Choice program, and Wellpoint Military Corp.
VA spokesman Curtis Cashour said the department is "different stages of acquisition of contracts" for the remaining three regions.
"Protests and contract negotiations will have zero impact on patient care, as covered veterans enrolled in community care programs will continue to receive care under VA's Patient-Centered Community Care Program—as provided by TriWest—while the protests are considered and negotiations continue," Cashour added.
Wilkie emphasized that satisfaction among veterans for the care they're getting at VA facilities is growing, as evidenced in surveys the department is sending out. He added that veterans are "voting with their feet."
Tester countered by saying that unless the facilities are staffed and functioning, that could change.
In one provision, the VA Mission Act authorized an "asset review" committee to determine which facilities are still operational or need investment . Wilkie told the panel he's likely going to seek authority to "accelerate" the launch of the commission tasked with that review "so it moves more rapidly than the timeline the committee has given."
The budget hearing with Wilkie and his top deputies followed a Democratic letter signed by 55 lawmakers from both chambers asking the secretary to re-evaluate the proposed access standards before finalizing them. Tester and House VA Committee Chair Mark Takano (D-Calif.) led the letter.
They blasted the department's current proposal, arguing that the "VA is now planning to designate all clinical services as potentially making a veteran eligible for community care under the 'designated access standards,' which marks a significant departure from Congressional intent."
"Given our concerns, we would urge the agency to re-evaluate the number and type of access standards the secretary is designating under the VA Mission Act," the letter stated. "We also strongly recommend the VA review its estimates of the budgetary impact of these standards. Finally, we believe that the department should remain the primary coordinator of care for all veterans, instead of setting up a system where it's possible that a subset of veterans will never see a VA doctor."